Date Format: MM slash DD slash YYYY
It is EXTREMELY important that we are able to reach you as soon as possible in the case of a medical emergency. Please provide us with a number where we can reach you directly at any point during the day of your pet's procedure
if you feel that you may be unavailable at any point during the day of your pet's procedure, use the space below to provide us with the name and contact information of a person that can make medical decisions for your pet on your behalf.
Use the space below to confirm the procedure(s) that we will be performing for your pet.
You should have received an estimate for your pet's procedure during your pet's last visit. Please acknowledge that you have received an estimate and agree to the costs of your pet's procedure
Sometimes patients are eligible for additional services like dental cleaning, lump removal, microchipping or vaccines, while they are under anesthesia. Please select one of the following options.
Please use the space below to list all medications that you will give your pet prior to his or her procedure, how much you will have given, and what time you will have given it. Please reach out to your East Side veterinarian if you are concerned if you should give your pet his or her medication prior to the anesthetic procedure.
Your pet should not have anything to eat or drink at least 10 hours prior to his or her anesthetic procedure. Please confirm that your pet will arrive to our practice fasted for 10 hours
In the extremely unlikely event that your pet experiences a medical emergency, we need to understand how you would like us to act. Please select from one of the following options.
This field is for validation purposes and should be left unchanged.